| NPI | 1811967748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C162697) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 209337) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2024-04-25 |